Provider Survey

VHA Homeless Programs - Project CHALENG for Veterans

Documents and Forms

Document Name Document Type
Form 10-10162 Provider Survey Form and Instruction
10-10162 CHALENG Survey - Provider 2900-0843 Survey (Provider) 2024-11-18.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Provider Survey	Agency IC Tracking Number:	2900-0843

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10-10162	CHALENG Survey - Provider	2900-0843 Survey (Provider) 2024-11-18.docx		Yes	No	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	3,200	3,200
Annual IC Time Burden (Hours)	320	320
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.